Pulp Therapy for Young Permanent Teeth

Question 1

What is the difference in pulp and dentine in young permanent teeth?

Answer 1

Pulp is larger and dentine deposition is incomplete

Question 2

What is the aim of pulp treatment in young permanent teeth?

Answer 2

Maintain vitality of young permanent teeth to allow continued physiologic development (laying down of dentine and formation of root apex)

Question 3

What are the types of pulp treatment procedures?

Answer 3

1. Protective liner
2. Indirect pulp cap
3. Direct pulp cap
4. Partial pulpotomy
5. Pulpotomy

Question 4

Why is there high success rate of pulp cap/pulpotomy in young permanent teeth?

Answer 4

Good blood supply via open apices

Question 5

Indication for DPC?

Answer 5

Young permanent teeth with small carious exposure

Question 6

What is Partial Pulpotomy?

Answer 6

Procedure whereby inflamed pulp tissue is removed to a depth of 1-3mm to reach healthy pulp tissue

Question 7

Indication of Partial Pulpotomy?

Answer 7

Young permanent vital teeth with carious/traumatic exposure + pulp hemorrhage is controlled after removal of superficial inflamed pulp tissue

Question 8

What is the procedure for Pulpotomy?

Answer 8

1. LA, isolation
2. Caries free
3. Remove 1-3mm of affected pulp
4. Irrigation with a bactericidal solution/saline e.g. sodium hypochlorite, chlorhexidine
5. Dry with cotton pellet
6. Place medicated cotton pellet (formocresol) over exposure site
7. Line pulpal floor with ZOE cement/RMGIC + Final restoration
8. Restore tooth with SS crown
9. Follow up

Question 9

What are the follow-up intervals after pulpotomy?

Answer 9

1 week: Ensure no discomfort

1 month: Sensibility test and radiograph

3 months: Radiograph to compare root development, hard tissue barrier formation seen sometimes

6 monthly for 3 years

Question 10

What to do after apex formation is completed?

Answer 10

1. Follow with routine elective RCT
2. Observe and do RCT only when S/S of pathosis, radicular calcification observed on x-ray or where final restoration for tooth is a post + crown

Question 11

What are the problems with non-vital immature permanent teeth?

Answer 11

1. Lack of apical stop to condense GP
2. “Blunderbuss” apex, difficult to obturate
3. Walls of immature root is thin and may fracture during instrumentation

Question 12

Management of Non-vital Pulp Therapy for Immature Permanent Teeth?

Answer 12

1. Promote formation of hard tissue barrier at apex
2. Apical closure (Apexification)
3. Regenerative endodontics

Question 13

Apical Closure Technique

Answer 13

1. Rubber dam isolation
2. Gain access into the pulp chamber
3. Remove non-vital coronal and radicular pulp

Question 14

Procedure for Apical Closure Technique?

Answer 14

1. Clean canal with gentle vertical movements, using a file
2. Alternate filing with irrigation using saline
3. Dry canal with paper points
4. Fill canal to apex with non-setting CaOH to disinfect canal5
5. Cotton pellet and seal cavity with TD
6. After 2-4 weeks, remove TD and wash out CaOH
7. If there is no exudate, place in MTA plug (3-5mm thick) to form an apical barrier
8. Put a collagen plug if MTA cannot achieve complete closure
9. Seal in wet sponge/paper + TD for 1 week to allow MTA to set
10. If no S/S. RF with thermoplastic GP. If walls are thin, canal space can be filled with MTA or CR
11. Restore tooth

Question 15

What is regenerative endodontics?

Answer 15

Revascularization with triple antibiotic paste

Question 16

Indications for Regenerative Endodontics?

Answer 16

For teeth with poor prognosis where MTA plug apexification may not work (very short roots, large open apex, very thin walls)

Question 17

Whar are the 3 antibiotics used in Regenerative Endodontics?

Answer 17

1. Metronidazole
2. Ciprofloxacin
3. Minocycline

Question 18

What is the aim of Regenerative endodontics?

Answer 18

1. Thickening of canal walls
2. Continued root development